Fecal Evacuation Disorder Among Patients With Solitary Rectal Ulcer Syndrome: A Case-control Study

Abstract

Background/Aims Data on frequency of fecal evacuation disorder (FED) among patients with solitary rectal ulcer syndrome (SRUS), hitherto an enigmatic condition, are scanty. Moreover, most such studies had limitations due to small sample size and lack of inclusion of healthy controls (HC). Methods Forty patients with SRUS underwent symptom assessments, sigmoidoscopy, anorectal manometry, defecography, balloon expulsion test (BET); endoscopic ultrasound (EUS) of anal sphincter complex was performed in a subgroup. Physiological tests (anorectal manometry and BET) were also performed in 19 HC. Results Patients with SRUS (26/40 male, age 37 [18–80] years) more often had FED than HC (10/19 male, age 43 [25–72] years) as shown by weight needed to expel the balloon (300 [0–700] g vs. 100 [0–400] g; P = 0.006), a trend towards abnormal BET (need of > 200 g weight for expulsion) (21/40 [53%] vs. 5/19 [26%], P = 0.058) and impaired anal relaxation (14/40 [35%] vs 2/19 [10.5%]; P = 0.048). Using Rome III criteria, most patients with SRUS reported having chronic constipation (36/40 [90%]) in spite of having normal (Bristol stool type IV, 21/40 [53%]) and diarrheal (types V, VI, VII, 6/40 [20%]) stool forms (Asian classification). SRUS patients more often (17/40 [43%]) had functional defecation disorder (Rome III criteria). Patients with SRUS with abnormal BET had thicker internal anal sphincter than those without (3.9 [3.4–7.0] mm vs 2.8 [2.0–4.0] mm; P = 0.01). Conclusions FED was commoner among patients with SRUS as evidenced by abnormal BET and sphincter relaxation. Those with abnormal BET had thicker internal sphincter on EUS than those without.

Risk Factors for Acute Hemorrhagic Rectal Ulcer Syndrome and Its Prognosis: A Density Case-Control Study

“…Fecal evacuation disorder was reported to be a potential risk factor for SRUS [ 8 – 10 ], and gut-directed biofeedback therapy is an effective behavioral intervention [ 8 , 9 ]. However, there have been few studies investigating risk factors and prophylactic interventions of life-threatening AHRUS.…”

Solitary rectal ulcer syndrome: clinical, endoscopic, histological and anorectal manometry findings in north Indian patients

“…In a recent prospective case control study from India, 17 of 40 SRUS patients had functional evacuation disorder. 17 In another recent controlled study, functional evacuation disorder was more common in the 11 patients with SRUS than in the 15 controls. 18 However, our study is one of the largest case control study showing association of SRUS with functional evacuation disorder.…”

Anorectal manometry in dyssynergic defecation: Are we there yet?

“…19 Internal sphincter intussusception is one of the consistent findings in DD seen on MRD. The findings in Behera's study 15 could have been emphasised further with use of MRD, as was done in the study by Sharma et al 7 The above studies stimulate the readers to conduct research to elucidate the etiopathogenesis of SRUS in a country where FED is probably a bigger problem than chronic constipation. 20 In this rapidly emerging competitive era of bio-technology, even minor deficiencies in investigations get highlighted.…”

“…In some centers, balloon BET is conducted in the left lateral decubitus position, wherein a rectal balloon is connected over a pulley; weights are added to provide external traction when necessary to facilitate expulsion of rectal balloon. 7 The left lateral position is unphysiological for defecation. Almost 36% of normal healthy subjects © Tropical Gastroenterology 2015 Editorial Tropical Gastroenterology 2015;36(4):217-219 exhibit a dyssynergic pattern in the lying position.…”